General Surgery Coding Alert

Question: The patient underwent gastric bypass (43644) with removal of gastric band and subcutaneous port (43774). If I include modifier 59, would we receive payment for removing the gastric band and port?

Texas Subscriber

Answer: The Correct Coding Initiative (CCI) bundles the band and port removal (43774, Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric band and subcutaneous port components) to the gastric restriction (43644, Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy [roux limb 150 cm or less]).

The edit does include a -1- modifier indicator, meaning you can append modifier 59 (Distinct procedural service) to report 43774 separately. But because the surgeon would have to remove a previously placed adjustable band and port, if present, before performing the gastric bypass, when you would be justified in charging separately for the band and port removal is unclear. You may achieve payment for 43774 using modifier 59, but a later audit of your billing will probably result in your having to refund that payment.

Bottom line: Medicare and other payers that follow CCI guidelines won't reimburse separately for band and port removal prior to gastric bypass.